States Must Decide On Joining High-Risk Pools

Friday is the deadline for states to tell the federal government whether they plan to participate in the $5 billion temporary program to let uninsured people with pre-existing medical conditions get health insurance between now and 2014. The federal government will have to run the program, which is set to begin in July, for states that opt out.

Today marks one of the first key deadlines for the new federal health care law. States have to tell federal officials whether or not they will run their own programs to let people with preexisting conditions get insurance.

As NPR's Julie Rovner reports, it's a crucial test of support for the new law.

JULIE ROVNER: The so-called high-risk pool program is one of the first part of the new health law to take effect. It's set to start July 1st. Jenny Backus, a spokeswoman for the Department of Health and Human Services, says it's aimed at some of the people who need help the most, those who are both uninsured and ill.

Ms. JENNY BACKUS (Spokeswoman, Department of Health and Human Services): It gives people access to care or access to the insurance market that they haven't gotten because insurance companies in 45 states in this country can deny people based on preexisting conditions.

ROVNER: The health law sets aside $5 billion for the program to help subsidize coverage for people who have such conditions and who have been uninsured for at least six months.

Ms. BACKUS: It was established as a bridge between where we are right now and where we're going at the end of implementation, which is new insurance markets, new exchanges in every state in the country.

ROVNER: But Backus said since many states already operate their own high-risk pools, HHS wanted to give them the option of using their share of the federal money to run this new program as well. As of midday today, she said 33 states had responded, 22 said they wanted to run their own program, and the response from the rest...

Ms. BACKUS: No, thanks. We'd like you guys to run it.

ROVNER: The state-based risk pools were originally a Republican idea, but most of those who've signed on so far have been Democratic governors. Most of those who will instead let the federal government run the program are Republicans.

Georgia is one of the states that declined to run its own high-risk pool. One reason, said Republican Insurance Commissioner John Oxendine, is that it's one of 18 states challenging the entire health law in court.

Mr. JOHN OXENDINE (Insurance Commissioner, Georgia): And we had serious concerns about the unprecedented situation of 38 percent of the American states challenging a law as being potentially unconstitutional.

ROVNER: But Oxendine, who is himself running for governor, says he's also worried about the merits of the high-risk pool, specifically whether there's enough money set aside to meet what he expects will be a high demand.

Mr. OXENDINE: It puts us in a situation: If the state creates it, if the state runs it and administers it and when it runs out of money, or if we have to freeze it and turn people away, people are going to be looking to the state and the state treasury to make good on these obligations.

ROVNER: But not all Republicans are so down on the idea. Among the seven Republican governors who have already said they will participate in the high-risk pool program is California Governor Arnold Schwarzenegger. Yesterday, he held a news conference to give the entire law his full backing.

Governor ARNOLD SCHWARZENEGGER (Republican, California): The bottom line is this: If national health care reform is going to succeed, it has to be a partnership between the state and the federal government. I am directing my administration to move forward very responsibly and as fast as possible.

ROVNER: Schwarzenegger also said he doesn't see the new health law as a partisan issue, but that probably puts him in a very small group.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR's programming is the audio.